Aortic root replacement with a pulmonary autograft

Aortic valve disease in the pediatric age group is usually a consequence of congenital aortic stenosis, which may be isolated or may be a part of an anomaly of the left ventricular outflow tract or the aortic root. Management of these patients is difficult. Neonates and infants with severe congenital aortic stenosis may suffer from congestive heart failure and are critically ill. Older children usually have less severe clinical symptoms, if it all. Invasive treatment is indicated in the case of severe aortic stenosis. For isolated congenital valvular stenosis, balloon valvuloplasty is the current therapy and is technically feasible in most patients. Therefore. surgical valvulotomy is no longer the first therapeutical option in managing aortic valve stenosis in neonates and in older children. Experience indicates that the outcome of both balloon valvuloplasty and surgical valvulotomy in patients with a non-tricuspid valve and the presence of aortic regurgitation is unfavourable. Both procedures can, to a certain extent, be regarded as palliative and may result in aortic valve regurgitation, ( usually when children are managed early in Iife. Rheumatoid diseases ll and endocarditis rarely cause aortic valve dysfunction (mostly aortic regurgitation) in this population. If invasive treatment is indicated and valvulotomy or valvuloplasty cannot be applied because of coexisting regurgitation or morphologic aspects, the aortic valve must be replaced. Aortic root replacement using the pulmonary autograft is a possible treatment modality in this respect. The discussion 011 when and how children must be managed will not be dealt with in the following chapters. This thesis presents aspects and results of the pulmonary autograft procedure in pediatric and adult patients. Aortic valve replacement in the pediatric population faces serious dilemmas and is a challenge for the cardiac surgeon.

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